M.Tech. / The aim of this study was to compare the effectiveness of two different treatment methods for myofascial pain and dysfunction syndrome of the Gluteus Medius muscle. This was done in order to determine whether or not a combined treatment of the integrated neuromuscular inhibition technique (INIT) and sacroiliac joint (SIJ) adjustive therapy was more effective than the INIT applied in isolation, in the treatment of the Gluteus Medius myofascial pain and dysfunction syndrome (GMMPDS). Participants were recruited using advertisement posters placed throughout the University of Johannesburg Doornfontein Campus and were treated at the University of Johannesburg Chiropractic Day Clinic. Thirty participants, between the ages of eighteen and fifty years, who were suffering from lower back pain and presented with Gluteus Medius myofascial trigger points (TrPs) and an SIJ dysfunction were selected for the study. They were randomly assigned into one of two groups, consisting of fifteen subjects each, as they entered into the study. Group one received the INIT to the affected Gluteus Medius muscle. Group two received a combination of the INIT to the affected Gluteus Medius muscle and an SIJ adjustment. Patients attended four sessions over a period of eight days and were treated on all of these sessions. Subjective and objective data were recorded on all sessions. Subjective data was recorded using the McGill Pain Questionnaire and the Numerical Pain Rating Scale. Objective data was recorded using the Universal Goniometer, to measure hip ranges of motion of the affected Gluteus Medius muscle, and the Wagner Pressure Algometer to measure pain-pressure threshold of the affected Gluteus Medius muscle TrPs. All of the data were statistically analyzed using Repeated Measures and Independent t-Tests. P-values were calculated to determine the statistical significance of the data. The results of the study indicate that both treatment methods are effective in treating GMMPDS, however a combined treatment approach of INIT and SIJ adjustive therapy was more effective in achieving a greater therapeutic response compared to INIT alone.

M.Tech. (Chiropractic) / Myofascial trigger points (MTrP’s) cause acute discomfort to intense pain and often lead to the use of pain medication as well as loss of man hours (Simons, Travell and Simons, 1999a; Tough, White, Cummings, Richards and Campbell, 2009). Dry needling is very effective and is widely used for the treatment of MTrP’s (Vulfsons, Ratmansky and Kalichman, 2012), but comes with various significant drawbacks, such as the experience of pain during or after treatment (post-needling soreness) or individuals with needle phobias (Unruh, Strong and Wright, 2002). More serious risks also exist, including damage to the viscera (Dommerholt and Fernández-de-las-Peñas, 2013). Low level laser therapy (LLLT) is a non-invasive technique and very little discomfort or pain is experienced by the patient during and after treatment. LLLT is effective in the short- and long-term relief of trigger points and myofascial pain syndrome. Therefore it can easily serve as an alternative to myofacial dry needling (Chow and Barnsley, 2005). This study aimed to determine whether LLLT or myofascial dry needling is more effective in the treatment of active MTrP’s, specifically those of the gluteus medius muscle. It also aimed to determine if LLLT could serve as an alternative treatment to dry needling in cases where dry needling is contraindicated or not desired. Thirty participants who complied with the inclusion criteria were divided into one of two groups. Group 1 (n=15) received dosages of LLLT directly to the active MTrP’s in the gluteus medius muscle and Group 2 (n=15) received myofascial dry needling to active MTrP’s in the gluteus medius muscle. Each participant attended 6 treatment sessions over a course of 2 weeks as well as a 7th measurements-only session.

M.Tech. / The aim of this research study was to determine the most effective way of treating sacroiliac joint dysfunction with associated gluteus medius trigger points, using adjusting of the sacroiliac joint or needling of the gluteus medius muscle or both. The participants were recruited randomly and placed in 3 different groups. Participants in group 1 were treated with an adjustment of the sacroiliac joint, as well as needling of the most prominent gluteus medius trigger point. Participants in group 2 were adjusted only and participants in group 3 were needled only. The treatment of the participants took place at the University of Johannesburg’s chiropractic day clinic. The objective data was acquired using a Digital Inclinometer to measure the ranges of motion at the spinal levels of the 5th lumbar vertebra and the first sacral vertebra (L5/ S1). An Algometer was used to measure the amount of pressure required to evoke pain, within the most prominent trigger point being treated. The subjective data was acquired using the Oswestry Pain and Disability Questionnaire, as well as the Numerical Pain Rating Scale. The results of the trial were of no statistical significance, but clinical improvement in both objective and subjective data was found. Group 2’s mean value percentage improvement was the greatest, when looking at range of motion. Group 1’s mean value percentage improvement was the greatest, with the Algometer and the subjective readings. The outcome of this study was that overall all three treatment protocols had a positive effect on the participants. Group 1 and group 2 had a slightly greater overall improvement. Thus it is suggested that when treating sacroiliac joint dysfunction with associated gluteus medius trigger points, the doctor can use an adjustment or adjusting with needling, both are effective. It is important to take the patients preference into account in order to make them feel at ease with the treatment they are receiving.

M.Tech. / This study aimed to determine the difference between the standard dry needling technique versus the rapid dry needling technique with regards to which technique would provide quicker relief of symptoms, as measured by an increase in participant’s pressure tolerance and range of motion and a decrease in subjective pain. Subjectively it was seen that both groups had a statistical decrease in the participants perceived pain with the Oswestry Disability Index, the McGill’s Pain Questionnaire and the Numeral Pain Rating Scale. Both groups showed significant changes over the two time variables (pre-Treatment one and post-Treatment four) with regards to all the questionnaires. Group 2 showed the most significant change when comparing the two groups with regards to the Oswestry Disability Index and the Numeral Pain Rating Scale. From these results it is seen that subjectively all the participants felt relief with respect to their perceived pain. However, objectively the rapid dry needling technique proved to improve pain faster and more consistently throughout the treatment period over the standard intra-muscular dry needling technique. Therefore the rapid dry needling technique is more effective in treating active Gluteus medius muscle trigger points.

Syfte: Att undersöka om det finns skillnader i muskelaktivering i lår- och sätesmuskulatur under belastad knäböj då den utförs med fri skivstång på axlarna respektive i Smith-maskin. Ett andra syfte var att undersöka om anteversionsvinklar kan påverka muskelaktiveringen.   Metod: Sexton deltagare utförde fem repetitioner av belastade (motsvarande 100% kroppsvikt) knäböj i två omgångar. En omgång i Smith-maskin och en i en fri bana. Tiden för varje knäböj standardiserades till fyra sekunder. Likaså standardiserades djup och fotposition. Ordningen mellan de två olika konditionerna slumpades. Muskelaktiviteten mättes genom att studiepersonerna bar shorts med insydda elektroder som mätte elektromyografisk aktivitet. Craig’s test användes före utförandet för att mäta anteversionsvinklarna hos deltagarna.  Resultat: När knäböjen utfördes i en Smith-maskin var det en lägre muskelaktivitet i mm. quadriceps jämfört med utförande i en fri bana. Tydligast var skillnaden under knäböjens första tre sekunder. Under andra och tredje sekunden var det även lägre aktivitet i hamstrings. Det var ingen skillnad i aktivitet mellan konditioner i m. gluteus maximus eller mellan studiedeltagare med femoral retroversion och neutral höftledsvinkel i någon av konditionerna.  Slutsats:  Resultaten indikerar att unga vältränade individer har en högre aktivitet i mm. Quadriceps under utförande av en belastad knäböj då den utförs i en fri bana jämfört med Smith-maskin. Även mm. hamstrings tycks aktiveras mer men endast i knäledens mest flekterade läge. Inga slutsatser kunde dras gällande skillnader mellan personer med femoral anteversion och femoral retroversion. Mer forskning behövs i området gällande anteversionsvinklar och dess påverkan på muskelaktivitet.

Sammanfattning:  Introduktion: Hamstringsskada är en av de vanligast förekommande skadorna inom fotboll, med betydande konsekvenser för individen. Hamstringsskador har visat sig svåra att rehabilitera. En riskfaktor bland många andra är nedsatt rörlighet i hamstrings. Studier har också visat att det finns samband mellan skador i nedre extremitet, däribland hamstringsskador, och nedsatt funktion i gluteus maximus (GM). Det finns teorier om att belastningen på hamstrings kan minska genom ökad användning av GM och att detta i förlängningen kan leda till minskad styvhet i hamstrings. Syfte: Att undersöka om träning av GM kunde påverka relativ styvhet i hamstrings mätt vid passivt rakt benlyft (PSLR) till dess att medrörelse i bäckenet uppstod, hos manliga fotbollsspelare, jämfört med en kontrollgrupp.  Metod: En prospektiv interventionsstudie med kontrollgrupp där interventionsgruppen under åtta veckor utförde övningar för att öka aktivitet och styrka i GM. Kontrollgruppen utförde bålövningar under samma tidsperiod. Utfall mättes i PSLR med EasyAngle goniometer före och efter intervention. En ANCOVA utfördes för att jämföra utfall mellan grupperna med baslinjemätningen som kovariat.  Resultat: I interventionsgruppen (n=14) ökade medelvärdet med 10° mellan mättillfällena. I kontrollgruppen (n=18) ökade medelvärdet med 2.9°. ANCOVAn visade en statistiskt signifikant skillnad (p <0.002) i den relativa styvheten i hamstrings mellan interventions- och kontrollgrupp efter avslutad intervention. Slutsats: Resultaten indikerar att träning av GM tycks kunna påverka relativ styvhet i hamstrings, även om resultatet ska tolkas med försiktighet utifrån studiens upplägg och storlek. Fler studier med interventioner som studerar effekter av träning av hamstrings synergister behövs.

Bakgrund: Trochanterrelaterad smärta anses bero på en bursit eller tendinopati i musklerna gluteus medius eller minimus. Smärtan uppstår när gluteal muskulatur pressas samman mot trochanter major av tractus iliotibialis när höften förs i en adduktion. Konservativ behandling är den primära behandlingsformen. Syfte: Syftet med studien var att genomföra en litteraturöversikt av aktuell litteratur (från 2018 och framåt) som undersökte konservativ behandling vid trochanterrelaterad smärta. Denna studie riktade in sig på interventionerna träning, inflammationsdämpande kortisoninjektion och stötvågsbehandling.Metod: Litteratursökningen genomfördes primärt i två elektroniska databaser: PubMed och Cochrane Library och kompletterades med sökningar i Google sholar samt skolans bibliotek. Sökorden togs fram via MeSH-termer (Medical Subject Headings) från Karolinska Institutet samt fritext. Sju studier mötte inklusionskriterierna och kvalitetsgranskades enligt en utvald mall för randomiserade studier. Evidensgradering utfördes på varje enskild originalstudie enligt en evidensmall. Resultat: Samtliga behandlingsformer; träning, kortisoninjektion och stötvågsbehandling, har visat på signifikanta skillnader i minskad smärta mellan grupperna utvärderat med NRS (Numeric rating scale) eller VAS (Visuell analog skala) och kortisoninjektioner och stötvågsbehandling har även visat på signifikanta minskningar i smärta inom grupperna. VISA-G (Victorian Institute of Sport Assessment – gluteal) uppvisar två signifikanta skillnader i ökad funktion i vardagen och ökad effektstorlek där träning och stötvågsbehandling har högre värde jämfört med kortisoninjektion. En signifikant skillnad i ökad livskvalitet ses hos deltagare som fått stötvågsbehandling. Evidensstyrkan uppmättes till måttligt stark. Konklusion: En oklarhet råder kring vilken behandlingsmetod som har den mest effektiva behandlingsstrategin. Forskningen visar på att en intervention, oavsett om den är aktiv eller placebo, är mer fördelaktig för personer med trochanterrelaterad smärta jämfört med vila.

Objective: The purpose of this study was to determine inter-rater and intra-rater reliability of synchronous ultrasound imaging and electromyography measures of lumbopelvic-hip muscle activity performed by a novice and an experienced investigator in healthy individuals. Electromyography (EMG) has served as the gold standard for quantification of onset of muscle activation; however, ultrasound imaging can visualize muscle activity when collected simultaneously. Methods: A novice and experienced investigator collected a series of 3 ultrasound images at rest and 3 M-mode clips during contraction of each muscle while EMG electrodes collected muscle activity. Muscles collected included: external oblique, erector spinae, rectus abdominis, gluteus maximus, and gluteus medius. Participants were asked to return 48-72 hours for a second session. After all muscles were collected, muscle thickness was measured from the US images and latency based on onset of activity from EMG was processed and averaged. Results: Moderate inter-rater reliability (ICC2,k=.5-.7) was found for most thickness, modulated thickness, and latency variables between the experienced and novice raters, however rectus abdominis had poor reliability compared to the other muscles assessed. Intra-rater reliability between sessions 1 and 2 for the novice rater revealed moderate reliability (ICC2,k=.5-.7) in the abdominal muscles (external oblique, erector spinae, contracted rectus abdominis) and poor reliability in the gluteal muscles. Conclusions: Modulated thickness values had the strongest reliability for inter- and intra-rater reliability, when thickness measures were divided by body weight in kilograms before analysis. Subcutaneous tissue, notably abdominal adipose, and its role on participant positioning should receive added attention during training and instruction of novice investigators during M-mode acquisition and timing of contraction with EMG synchronization.

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